Di Mitri Roberto, Mocciaro Filippo, Pallio Socrate, Pecoraro Giulia Maria, Tortora Andrea, Zulli Claudio, Attardo Simona, Maurano Attilio
Roberto Di Mitri, Filippo Mocciaro, Giulia Maria Pecoraro, Simona Attardo, Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy.
World J Gastrointest Endosc. 2016 Oct 16;8(18):646-652. doi: 10.4253/wjge.v8.i18.646.
To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment.
From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram).
Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography ( = 0.031), DASE as first approach ( = 0.032), and cannulation of major papilla followed by guidewire insertion ( = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications ( = 0.01).
DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.
通过意大利三个治疗胆胰疾病的转诊中心，报告扩张辅助结石取出术（DASE）在临床实践中的应用数据及其疗效和安全性。
2011年1月至2015年12月，我们收集了120例行DASE治疗患者的数据。当内镜医师能够将球囊经乳头置入并充气至最终直径并维持足够时间（至少30秒）时，即获得技术成功。结石完全清除（胆管造影未见残留结石）后获得临床成功。
纳入49例男性（40.8%）和71例女性（59%）。平均年龄为67.8岁±15.7岁。胆总管（CBD）平均扩张为19.2mm±3.9，结石平均大小为15.8±2.9。38%的患者将DASE作为首选方法（结石取出初始失败后为62%）。技术成功率和临床成功率分别为91%和87%。对于DASE失败的患者，采用了替代治疗。DASE术后18%的患者出现并发症（出血9%，胰腺炎8%，穿孔0.8%）。单因素分析显示，选择性内镜逆行胰胆管造影（=0.031）、将DASE作为首选方法（=0.032）以及主乳头插管后插入导丝（=0.004）与低并发症风险相关。预切开与并发症风险增加相关（=0.01）。
DASE可提高首次治疗成功率，不仅对于较大的CBD结石，也可被视为内镜括约肌切开术的有效替代方法。
